Provider Demographics
NPI:1134796907
Name:HALE, VICKIE LYN
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:LYN
Last Name:HALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 S DENVER ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3938
Mailing Address - Country:US
Mailing Address - Phone:801-889-5176
Mailing Address - Fax:
Practice Address - Street 1:770 S DENVER ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3938
Practice Address - Country:US
Practice Address - Phone:801-889-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker